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Published on: August 17, 2022
Risk Factors Associated with Increased Morbidity in Living Liver Donation
Helry L Candido1, Eduardo A da Fonseca1, Flávia H Feier1
1Hepatology and Liver Transplantation, Hospital Sírio-Libanês, Rua Barata Ribeiro 414, cj 65, 01308-000 Bela Vista, SP, Brazil; Hepatology and Liver Transplantation, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
Insights
Living donor liver donation (LDLD) carries risks. Right lobe resection, smoking, and blood transfusions significantly increase the likelihood of postoperative complications (POCs) in living liver donors.
Area of Science:
- Transplantation Surgery
- Hepatobiliary Surgery
- Surgical Risk Assessment
Background:
- Living donor liver donation (LDLD) is a vital alternative to deceased donor liver transplantation.
- Assessing and mitigating risks for living donors is crucial for the success of LDLD programs.
Purpose of the Study:
- To identify risk factors for postoperative complications (POCs) in living liver donors.
- To develop a predictive score for POCs following LDLD.
Main Methods:
- Retrospective cohort study of 688 living liver donors (June 1995 - February 2014).
- Analysis included donor demographics, surgical factors (resection type), and outcomes.
- Primary outcome: POCs graded ≥III (Clavien-Dindo classification).
Main Results:
- Overall POC rate was 6.2% (43/688 donors).
- Right lobe resection (RL) had a significantly higher POC rate (16.1%) compared to left lateral segment (4.5%) and left lobe (5.5%) resections.
- Independent risk factors for POCs included RL resection, smoking status, and intraoperative blood transfusion.
Conclusions:
- Right lobe resection, smoking, and intraoperative blood transfusion are significant risk factors for POCs in living liver donors.
- These factors should be considered when evaluating donor safety and developing predictive models for LDLD.
Abstract:
Living donor liver donation (LDLD) is an alternative to cadaveric liver donation. We aimed at identifying risk factors and developing a score for prediction of postoperative complications (POCs) after LDLD in donors. This is a retrospective cohort study in 688 donors between June 1995 and February 2014 at Hospital Sírio-Libanês and A.C. Camargo Cancer Center, in São Paulo, Brazil. Primary outcome was POC graded ≥III according to the Clavien-Dindo classification. Left lateral segment (LLS), left lobe (LL), and right lobe resections (RL) were conducted in 492 (71.4%), 109 (15.8%), and 87 (12.6%) donors, respectively. In total, 43 (6.2%) developed POCs, which were more common after RL than LLS and LL (14/87 (16.1%) versus 23/492 (4.5%) and 6/109 (5.5%), resp., p < 0.001). Multivariate analysis showed that RL resection (OR: 2.81, 95% CI: 1.32 to 3.01; p = 0.008), smoking status (OR: 3.2, 95% CI: 1.35 to 7.56; p = 0.012), and blood transfusion (OR: 3.15, 95% CI: 1.45 to 6.84; p = 0.004) were independently associated with POCs. RL resection, intraoperative blood transfusion, and smoking were associated with increased risk for POCs in donors.
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